Learning to Swim in The Alphabet Soup of the DSM

Monthly Archives: November 2016

Dr.Phil. What are the prevailing opinions regarding Dr. P? I have never watched his show, but I don’t live under a rock either. It’s hard not to be aware of his no nonsense, shoot from the hip, straight talk. Americans love gossip and drama, and they love reality television. It’s like red meat and red wine.

“And tonight we will be having a titillating show in which Tom is caught redhanded! We will pair that with high drama best exemplified by Martha’s throwing her drink in his face, and her ex-best friend will see this and tweet about it causing the entire bridge club of the White Haven Bridge Society to stop drinking their gin and tonics for five minutes !”

Dr. Phil has made his name and money on the backs of people’s pain and misfortune. They have agreed to it by appearing on his show and airing their dirty laundry in front of America. I suspect that people feel better about their lives by partaking of the hidden miseries of the lives of others. Dr. Phil has been more than happy to oblige them.

This latest show, however, has me asking questions, and I don’t know the answers.

Dr. Phil has interviewed actress Shelley Duvall most well-known for her roles in The Shining and Popeye. She has been out of the spotlight for almost 20 years, and this is the first time she has been seen. Duvall is mentally ill with what looks to be a psychotic disorder or dementia. To be honest, she speaks like and has the affect of someone with a schizophrenia spectrum disorder.

Dr. Phil is under heavy fire from certain people in Hollywood for this interview and receiving press attention, too. Is he doing this for ratings and, thusly, exploiting Duvall, or is he merely trying to help Duvall? I’m not sure.

Mental illness is no different than any other kind of illness in terms of the body experiencing disease. There are many contributing factors. In the case of a schizophrenia spectrum disorder, it is, like MS, a neurodegenerative disease. The illness itself is a manifestation of a brain-based, neurological disease.

Were people all up in arms when Michael J. Fox was being interviewed, his Parkinson’s Disease symptoms on full display? What about the countless documentaries on early-onset Alzheimer’s? How many interviews have been done with people experiencing dementia? Were people protesting then claiming exploitation and cruelty? No. What about news programs and documentaries featuring cancer patients in the throes of treatment manifesting symptoms of “chemo brain”? No one was tweeting that the directors were cruel and exploitative then.

So, what about this particular interview is pushing buttons? Duvall herself admits to needing help. She says, “I’m sick. I need help.” She also answers questions that clearly reveal positive symptoms elucidating some kind of underlying psychosis. It’s upsetting to watch. But what if psychosis weren’t stigmatized in our society?

What if psychosis were viewed as an indicator of a disease process in the brain, and everyone knew that. People would then see this interview and say, “Oh my. Ms. Duvall needs a medical intervention. I feel sad that she is ill now,” instead of reeling back in horror. You see, I don’t think that the root of people’s outrage over this interview is related to Dr. Phil’s tendency to ride the coattails of people’s misfortune. If everyone were authentically outraged over this, then more letters to the press would have been written sooner. Nothing that Dr. Phil is doing is new. He’s the same misery vampire as ever, and the American people have loved it. His show is still on the air. It’s in its 14th season.

I carefully submit that people are horrified by Ms. Duvall and the manifestation of her illness. It’s shocking. It is abnormal, and no one wants to see it. My question is this: How is mental illness to ever be normalized as part of the human experience unless people with negative, positive, and cognitive symptoms are introduced to people who are not acquainted with them? Mental illness is so stigmatized in our world. It is hidden and shamed. Few people outside of the reality of it want to talk about it in meaningful ways, and, when it is discussed and put out there bluntly, those with it are pitied or referred to as undignified. That is actually the perpetuation of stigma.

Americans are very comfortable with mockery and making that which is quotidian and quite normal profane. Disease in America is the norm. It has become normal, and mental illness is normal as well because it is a disease process; but most Americans distance themselves from it through objectification and mockery. How many Halloween costumes involve mocking those with mental illness–straight jackets, references to mental illness in the costumes themselves, and movie and comic book characters who are anti-heroes due to a mental illness e.g. The Suicide Squad. It is an hyberbolic surreality that proliferates due to distancing behaviors rooted in stigma and fear.

What Dr. Phil is doing, while distasteful, may not be a bad thing. The only thing that I might question is Ms. Duvall’s agency, and this is where dignity and potential exploitation come into play. When we lose our agency to a disease, our dignity becomes dependent upon our caregivers. Was Ms. Duvall acting on her own behalf, or was someone else acting on her behalf when the agreement was made to do this interview? Was her fundamental right to privacy violated by someone else acting as her power of attorney?

At the same time, do people ask these questions of other people manifesting diseases who participate in interviews? If not, then why? Why is there a double standard? Once again, I think that it may be due to the lack of societal normalization of mental illness perpetuated by stigma. Someone has to go first and show the world what it looks like–and not in a movie for the purpose of entertainment. Then, someone must go second, third, fourth, etc. The world must get comfortable with what it has always chosen to hide and avoid.

Why? 75% of Americans will, at some point, require help for mental illness of some kind. That would probably be a smaller number if 100% of Americans were willing to support them.

This might be an odd topic to discuss, but it’s actually very important in terms of adolescent mental health particularly if there is a biologically-based brain disorder on the table.

What happens when puberty strikes?

Let me get this off my chest. I hate the word ‘puberty’. I don’t know why. It’s a weird word, isn’t it? I don’t even like to say it aloud. “Puuuuuuuuuberty.” No. Just…no.

What else can I call it? Game Day? The Dawn of a New Age? Rites of Passage? Pledge Week? These all sound like terrible movies, cults, or something that happens to you at a Greek Week event. But, isn’t that what puberty feels like? I digress…

Everyone warned me that puberty would be an über nightmare for Grace as opposed to the standard nightmare that the neurotypical folks experience because the sudden surge in hormones might possibly increase the intensity of her diagnosis–schizophrenia spectrum disorder. I winced. It is a valid concern because onset of puberty is often the time when schizophrenia and bipolar spectrum disorders emerge. If you have a child who has a childhood-onset diagnosis, then what might puberty change or exacerbate?

So, how has it been?

Well, the first thing to note here is that Grace has been taking Abilify since she was 11 years-old, and Abilify affected her sexual development. She didn’t experience any signs of puberty until she was well into her 15th year. That’s late. It was concerning. We were almost referred to an endocrinologist.

The second thing to note is that her symptoms were in no way exacerbated by her diagnosis. She was a very typical teenager if ‘typical’ is a thing. In other words, her behavior and thoughts were well within the bell curve for what I would define as normative although she has favored emo-angsty self-expression for about a year. It’s like living with a character from a knock-off John Hughes movie. The month prior to menarche (another word that should never be used), however, she became an asshole, and no one knew why.

Also, she wanted to snort and mainline sugar. I had to practically build a wall between her and the kitchen just to keep her away from anything potentially sugary–even granulated sugar! She hated everything as well. She was rude. She wanted to be left alone. Everything was bad. And, she cried all the time. She is my third daughter. I’ve seen all this before but not quite at this level. A friend commented, “Wow, she just hates everything.”

Well, when her first period arrived, it all crystallized, and her mood cleared up. It’s damn hard being a girl.

We did not, however, have any psychotic symptoms. We did not have a surge in mania. It was fairly typical. Everyone in the house gets a bit moody and upset as their hormones ebb and flow. Doireann cries. Eadaoin gets punchy. Grace hates everyone and everything. I feel irritable. It is life. You learn to go with the flow (sorry about the pun…).

The good news? There was no apocalypse, and that means a lot because more than a few people prognosticated the end of the world for Grace when Shark Week hit.

So, should you be in a similar situation, wondering how your child will do when the surge of hormones bathes their brain in all the colors of the moody, developmental rainbow, have hope. Sometimes things go smoothly and everything works out.